Abstract: Objective To systematically review the efficacy and safety of fondaparinux and enoxaparin in the prevention of
venous thromboembolism (VTE) after major orthopedic surgery. Methods The MEDLINE, EMbase, the Cochrane Library,
CNKI, CBM, VIP and Wanfang databases (from their establishment to October, 2012) were searched for randomized controlled
trials (RCTs) comparing the effects of fondaparinux and enoxaparin in preventing VTE after major orthopedic surgery. The
related journals and conference papers were manually searched. The outcome measurements were the incidence of total VTE,
deep venous thrombosis (DVT), symptomatic VTE, pulmonary embolism (PE), major bleeding and any other adverse event.
The quality of literatures was evaluated and the data were extracted for meta-analysis. Results Five RCTs involving 7611
patients were included pertaining to major knee surgery (1 RCT), hip fracture surgery (2 RCTs) and total hip arthroplasty (3
RCTs). The incidences of total VTE and DVT were significantly lower in fondaparinux group than in enoxaparin group [RR=
0.52, 95%CI (0.40,0.67), P<0.00001; RR=0.49, 95%CI (0.42, 0.58), P<0.00001]. The incidence of symptomatic VTE was similar
between the two groups [RR=1.52, 95%CI (0.80,2.88), P=0.20]. Fondaparinux was associated with a significantly increased
incidence of major bleeding compared to enoxaparin group [RR=1.55, 95%CI (1.14,2.12), P=0.006], but the mortality rates were
comparable between the two groups [RR=0.93, 95% CI (0.63,1.37), P=0.72]. Conclusion Compared with enoxaparin,
fondaparinux can reduce the risk of postoperative VTE and do not increase the mortality rate following major orthopedic
surgery though with an increased risk of major bleeding.